FillMapGold Classic Standard · 91908-91908OK0010053-0About this plan

Does Gold Classic Standard cover immunoglobulin G?

1 · Your plan

Gold Classic Standard

91908-91908OK0010053-0 · ACA · ACA Marketplace

2 · Your medication

immunoglobulin G

immunoglobulin Gunder Gold Classic Standard

Covered — requires prior authorization

Your plan has to approve it first — your doctor’s office handles it.

What you'd pay

$250per 30-day fill

From the first fill — no deductible on this drug.

This is the standard amount. If you qualified for a cost-sharing reduction when you enrolled, set your level above and this will follow it.

Tier: Specialty drugs
Approval first: Required
Try another first: No
Amount limit: None

Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.

Your cost-sharing levelMarketplace plans publish a different amount for each level. Your eligibility notice says which applies. Nothing here is saved.

Covered forms and strengths (32)

10 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]Approval first
10 ML immunoglobulin G, human 100 MG/ML Injection [Gammaked]Approval first
10 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
100 ML immunoglobulin G, human 100 MG/ML Injection [Flebogamma]Approval first
100 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]Approval first
100 ML immunoglobulin G, human 100 MG/ML Injection [Gammaked]Approval first
100 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
100 ML immunoglobulin G, human 100 MG/ML Injection [Octagam]Approval first
100 ML immunoglobulin G, human 50 MG/ML Injection [Flebogamma]Approval first
100 ML immunoglobulin G, human 50 MG/ML Injection [Octagam]Approval first
20 ML immunoglobulin G, human 100 MG/ML Injection [Octagam]Approval first
20 ML immunoglobulin G, human 50 MG/ML Injection [Octagam]Approval first
200 ML immunoglobulin G, human 100 MG/ML Injection [Flebogamma]Approval first
200 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]Approval first
200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaked]Approval first
200 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
200 ML immunoglobulin G, human 100 MG/ML Injection [Octagam]Approval first
200 ML immunoglobulin G, human 50 MG/ML Injection [Flebogamma]Approval first
200 ML immunoglobulin G, human 50 MG/ML Injection [Octagam]Approval first
25 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]Approval first
25 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
300 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]Approval first
300 ML immunoglobulin G, human 100 MG/ML Injection [Octagam]Approval first
400 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
400 ML immunoglobulin G, human 50 MG/ML Injection [Flebogamma]Approval first
50 ML immunoglobulin G, human 100 MG/ML Injection [Flebogamma]Approval first
50 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]Approval first
50 ML immunoglobulin G, human 100 MG/ML Injection [Gammaked]Approval first
50 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
50 ML immunoglobulin G, human 100 MG/ML Injection [Octagam]Approval first
50 ML immunoglobulin G, human 50 MG/ML Injection [Flebogamma]Approval first
50 ML immunoglobulin G, human 50 MG/ML Injection [Octagam]Approval first

← All coverage for immunoglobulin G